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PubMed1992

America's children: economic perspectives and policy options.

American children are worse off than those in the previous generation in several important dimensions of mental, physical, and emotional well-being. During the 1960s cultural changes adversely affected children while their material condition improved substantially. By contrast, material conditions deteriorated in the 1980s, especially among children at the lower end of the income distribution. Public policies to improve the material condition of children require a transfer of resources from households that do not have children to those that do. Government programs such as tax credits and child allowances are more efficient and equitable than employer-mandated programs.

Adult↗
PubMed1994

Health and social inequality in Europe.

In most European countries health has been shown to be linked to social circumstances--gradients in health status have persisted for decades, despite major changes in the principal causes of death. In central and eastern Europe life expectancy has stagnated since the mid-60s, whereas in the West it has increased; but even in the West it is related to income distribution. Social differences in mortality in men are three times as large in some countries as in others, and are influenced by factors other than conventional risk factors. Substantial declines in mortality and morbidity could result from a narrowing of health inequalities even when differences in health risk between social groups are comparatively small. Policies to reduce health inequalities can be introduced in smaller communities and organisations such as the school and workplace. National policies are variable; factors generating inequalities require action across several policy areas.

Europe↗
PubMed1997

Self reported poor health and low educational level predictors for mortality: a population based follow up study of 39,156 people in Sweden.

OBJECTIVE: To analyse the relative risk (RR) of mortality for people who reported poor health or had low educational level. SETTING: Sweden. DESIGN: A random sample of 39156 people was interviewed face to face by Statistics Sweden from 1979-85. The dependent variable was total mortality. Independent variables were sex, age, marital status, and socioeconomic position, defined as educational level, type of housing tenure, and health status. This study was designed as a follow up study ranging from 1 January 1979 to 31 December 1993. Information on the dependent variables was obtained from the central cause of death register. Respondents were linked to the register by the Swedish personal registration number. Person-years at risk were calculated from the date of the interview until death, or for those who survived, until the end of the follow up period. Data were analysed in relation to gender and age (25-29 years and 60-74 years) in a proportional hazard model in order to estimate RR. RESULTS: During follow up 2656 men and 1706 women died. Men and women in both age groups who reported poor health status at the interview had a strongly increased risk of dying during the follow up period (RR = 2.05 (95% confidence interval 1.72, 2.31) and RR = 1.91 (1.74, 2.10) for men, and RR = 2.34 (1.94, 2.83) and RR = 1.80 (1.61, 2.02) for women for the younger and older age groups respectively) when simultaneously controlled for age, marital status, education, and housing tenure. Living alone, renting an apartment, and low educational level (< or = 9 years) were also associated with increased mortality risks for men and women in both age groups. CONCLUSION: Poor self reported health was a strong predictor for total mortality. Furthermore, in Sweden, a country well known for the equality of its income distribution, there are inequalities in health with higher total mortality risks for people with a low educational level and those who are not owner-occupiers.

Adult↗
PubMed1997

Urbanisation and psychiatric admission rates in The Netherlands.

This article discusses the possible links between urbanisation, demographic variables and psychiatric admission rates. Inpatient psychiatric admission rates were determined for the 647 Dutch municipalities. Then urbanisation was determined using 'area address density', a unit of measurement developed by the Dutch Central Statistical Office. Five degrees of urbanisation are distinguished. Twenty-nine demographic variables which might have a theoretical link with admission rates were collated for all municipalities. The results show that standardised total admission rates increase with urbanisation. The mean admission rate for the least urbanised municipalities is 2.02 per 1000 resident population, the rate for the most urbanised municipalities is 3.72 per 1000. It was then found that the prevalence of demographic risk factors increased with urbanicity. At the same time, it was found that almost all demographic variables correlated with admission rates. A multiple regression mode--which accounts for 22% of variance--shows that income distribution, address density and mortality all contribute significantly to the variance in admission rates for the 647 Dutch municipalities.

Adolescent↗
PubMed1997

Prevalence, incidence and stability of drinking problems among whites, blacks and Hispanics: 1984-1992.

OBJECTIVE: This article reports on the prevalence, incidence and stability of dependence-related problems and social consequences from drinking among whites, blacks and Hispanics between 1984 and 1992. METHOD: A probability sample of 1,777 whites, 1,947 blacks and 1,453 Hispanics from the U.S. adult household population was interviewed in 1984. In 1992 a subsample consisting of 788 whites, 723 blacks and 703 Hispanics was reinterviewed. Interviews averaging 1 hour in length were conducted in respondents' homes by trained interviewers. RESULTS: The prevalence of a number of alcohol-related problems, the stability and incidence of dependence-related problems and the incidence of social consequences from drinking are higher among Hispanic than among white men. Dependence-related problems are more stable among black than among white men. Among women, the incidence of dependence-related problems and social consequences from drinking is higher among blacks than whites. Hispanic women have a higher incidence of social consequences from drinking than white women. Having a problem at Time 1 correlates only moderately with having a problem at Time 2, independent of ethnicity. CONCLUSIONS: In general, Hispanics and blacks continue to be more at risk than whites for developing a number of alcohol-related problems. These two ethnic groups should be the focus of renewed efforts to address alcohol problems and inequalities in income distribution, employment, education and lack of access to adequate health care.

Adolescent↗
PubMed1996

[Demographic profile and health conditions of the elderly in a community in an urban area of southeastern Brazil].

Some specific characteristics of the aging of the Brazilian population in different areas, states and communities all over the country, have shown significant variations. Historical series of demographic and health indicators for the population in their sixties and over in Brazil, state of S. Paulo and in the municipal district of Araraquara are listed as follows: level of education and urban population growth rate, income distribution, mortality rates and main causes of death. In 1991 the aged constituted were 7.8% of the Brazilian population and 9.7% in Araraquara community. The elderly population (of 70 years of aged and above) as a proportion of the whole, has increased and already stands for 40%. The same trend holds good for both the proportion of aged within the urban population and their level of education which increased to 90% in 1991. The main causes of death are chronic degenerative diseases which have replaced the infectious illness: first, the diseases of the circulatory system (which account for more than 40% of all deaths) and the neoplasms (which let to 15% of the deaths). On the basis of these health and demographic data relating to people of 60 years of age and over, this study suggests some procedures for the improvement of the quality of the assistance given to the target population: a) the assistance give to the aged should be improved by providing gerontological training for general physicians and nurses, both of public and private clinics; b) the already existing educational activities for the aged, for health workers and for teachers of secondary education should be further developed; c) the number of day-hospitals should be increased for the purpose of avoiding unnecessary confinement so as maintain the low rate of institutionalization in homes for the elderly (0.7% in Araraquara). It is reported that at least 35% of the aged population in this area is entitled to private health assistance, which brings out the importance of including such services in the local health programs for this group.

Aged↗
PubMed1985

Public opinion about doctors' pay.

Public opinion about doctors' incomes was examined in a national random sample of 843 respondents; 70.1 per cent of those questioned felt physicians are overpaid. There was a high degree of agreement among various groups that physicians are overpaid, but older people and Whites were more likely to think so than younger people and other ethnic groups. People who believe that the United States is characterized by unequal educational opportunity, unfair income distribution, and limited resources were also more likely to think physicians are overpaid.

Adult↗
PubMed1997

In pursuit of "growth with equity": the limits of Chile's free-market social reforms.

The economic and social strategy developed by the democratic governments in Chile since 1990 has been based on the premise that free-market policies promoting growth and economic stability must continue, but should be combined with social policies designed to promote greater equality. This new set of policies produced quick and positive results in the context of strong economic growth. The reduction of poverty was its crowning achievement. However, not all the Concertación's redistributive efforts have enjoyed the same level of success. Inequalities in income distribution are again increasing. Significant segments of society, such as subsistence farmers, rural migrants to cities, women and youth who lack vocational training--as well as an important segment of the middle class that had been impoverished during the military regime--are being systematically marginalized from the benefits of economic growth and social policy. The fundamental problems of current Chilean social policy are rooted in the privatization of social sectors under the military government and the resulting dual model of social welfare.

Chile↗
PubMed1992

[Aflatoxins and primary liver cancer--a population based case-control study].

A case-control study of primary liver cancer (PLC) was conducted in 1989 at Fusui County, Guangxi Province. There were 99 PLC cases and 99 age-sex-residence matched controls. There were no difference of age, sex, race, cultural, level, marital status and annual income distribution (P > 0.05). The mean dietary AFB1 intakes of cases and controls were 117.72 + 105.68 mg/d, the mean outputs of AFM1 were 22.56 and 21.62 ng per morning urine respectively. The mean sera aflatoxin-albumin adducts in both groups were 24.96 and 18.72 pg per mg albumin respectively. These indicators were of no statistical significance. Conditional Logistic regression showed that HBV infection (OR = 5.33), drinking pond-ditch water (OR = 3.70), family history of PLC (OR = 2.88), and total alcohol intakes (OR = 1.002) were statistically significant as risk factors (P > 0.05) rather than aflatoxins. This may be due to the fact that the samples selected in hyperendemic area both took high quantities of aflatoxin.

Aflatoxin B1↗
PubMed1989

Nutritional impacts of an increasing fuelwood shortage in rural households in developing countries.

Developing countries face the problem of an increasing fuelwood shortage. For rural households, fuelwood is the main source of energy. As energy is essential to make food suitable for human consumption by means of cooking, the present fuelwood crisis could jeopardize the nutritional situation of rural households. This article reviews and analyses available data and information on the relationship between the availability of fuelwood and the nutritional situation of rural households. Based on analysis of emperical studies, three main strategies evolved by rural households, especially by the women within these households, to cope with a shortage of fuelwood can be distinguished: (i) increase in time and energy spent on fuelwood collection, (ii) substitution of fuelwood by alternative fuels and (iii) economizing on the consumption of fuelwood and alternative fuels. These coping-strategies affect food supply, food preservation, preparation and distribution, income generating activities and food consumption, all of which result in a decrease in quality and quantity of food consumed and in a deterioration of physical condition, especially women and their young children. Available data on fuelwood availability and nutrition are rather diffuse and incomplete. The presence of several confounding variables in the studies analysed make it difficult to establish the nutritional impact of a growing shortage of fuelwood. Nevertheless, it is concluded that a shortage of fuelwood plays at least an important role in changes in nutritional situation of rural households. If current trends continue, this role will become more important and evident. The impact of a growing fuelwood shortage should be a point of concern for rural development.

Cooking↗
PubMed1979

Physical changes of the environment and health effects with special reference to water pollution and sanitation in Malaysia.

Development of a human community are not without changes in its environment. Such changes result in either beneficial or adverse effects on human health. In Malaysia, in the wake of the New Economic Policy aimed at the redressing of the poor population and income distribution, development of the nation has brought about various changes in the environment. Some of these changes have elevated basic public health problems, while others, particularly new agricultural practices and industrialisation programmes with urbanisation trends, have brought a new set of problems due to water pollution and sanitation. Various measures are being taken to protect and to improve the environment so that progress can be realised with minimum adverse effects. This also calls for assistance from international sources, in terms of expertise, training and funds.

Communicable Diseases↗
PubMedDate not supplied

[Present population development and decision problems in the frame of social security for the aged].

Under the condition that current demographic conditions and the legislation of the old-age insurance will stay as they are now it is to calculate on a higher ratio of pensioners to work in the year 2030. The resulting financing requirements are neither only to be solved by appropriately high old-age insurance contributions nor by a reduction of the pensions level. Some measures for a relief of these problems are discussed with their advantages and disadvantages to economic growth and income distribution. But since measures partly need a decision in 20-40 years only, it is to be required for the moment that no steps are taken now which make the financing requirements more difficult at that time.

Aged↗
PubMed1993

The costs of schizophrenia. Assessing the burden.

Much has been learned about the costs of schizophrenia during the last three decades. Assessing the costs is a challenging task given the complexity of the disease. Much can be done to refine the methodologies of cost of schizophrenia studies based on the human capital approach and to develop the conceptual framework for a consistent account of the income distribution effects of the disease. The knowledge base, however, is quite extensive and data presented here indicate that although people with schizophrenia account only for about 1% of the adult population, they consume about 2.5% of total annual health care expenditures, they constitute about 10% of the totally and permanently disabled population, and comprise as high as about 14% of the homeless population in some large urban areas. These data clearly indicate the negative economic consequences of the disease: People with schizophrenia tend to be high users of medical care and tend to concentrate in subpopulations that are highly dependent on public assistance funds as a result of the disabling nature of the disease. These negative economic consequences of schizophrenia provide a powerful economic case for developing strategies to improve treatment effectiveness through biomedical and services research.

Cost of Illness↗
PubMed1995

[Breast feeding and the nutritional status of Chilean children].

The purpose of this work was to describe the diet of children under 18 months of age and its relationship to nutritional status. For this purpose, in 1993 a prevalence study was carried out on children who received care from the National Health Services System of Chile. The Chilean public health system provides care to 75% of children under 6 years of age and especially to children of families in the lower strata of income distribution in the country. Participants in the study were 9330 children under 18 months old who were randomly selected from 102 of the 320 urban clinics throughout the country. The type of food these infants had received the day prior to the interview (breast milk exclusively, breast milk plus solid food, formula exclusively, formula plus solid food) and their nutritional status relative to the standards of the National Center for Health Statistics (United States of America) and of WHO were determined. Children with z values for weight-for-age between -1.0 and -2.0 standard deviations were considered at risk for malnutrition, and those with z values under 2 standard deviations were classified as malnourished. The prevalences of exclusive breast-feeding at the first, third, and sixth months of life were 86.5%, 66.7%, and 25.3%, respectively. Some 12.1% of the participants showed low weight for age; 30.7%, low height for age; and 35.7%, overweight. The magnitude of weight-for-age deficiency was 1.2 to 5 times greater among children who were fed milk substitutes than among those who received breast milk. Breast-feeding also had a positive effect on height. These results confirm the benefits of exclusive breast-feeding until 6 months of age, the need to supplement the child's diet with solid food after that age, and the breast-feeding's protective effect on the nutritional status of children of all the ages studied.

Body Height↗
PubMedDate not supplied

Income inequality and population health.

A number of studies have suggested that inequalities in the distribution of income may be an important cause of variations in the average level of population health among rich industrial nations. However, what is missing from the debate so far is any systematic review of evidence about the relationship between different measures of income distribution and indicators of population health. This paper aims to bridge that gap. First, it summarizes the recent English language literature on this topic and illustrates the methodological problems that weaken the inferences that can be derived from it. Secondly, it presents new empirical estimates of the relationship between different measures of income distribution, infant mortality and life expectancy based on the most authoritative data published to date. In contrast to most earlier studies, we find very little support for the view that income inequality is associated with variations in average levels of national health in rich industrial countries. Some possible explanations for these differences are outlined.

Developed Countries↗
PubMed1978

[The effects of the social security system on the life situation of old people (author's transl)].

The situation of old people is determined by the system of Social Security in a various way. A point of most importance are effects of pensions etc. on the distribution of income. It is shown, that distribution of old-age pensions follows the same scheme, which is dominating in the distribution of primary income. This is due to the basic principles of the Social Security System, which intensify inequality.

Aged↗
PubMed1996

Inequality in income and mortality in the United States: analysis of mortality and potential pathways.

OBJECTIVE: To examine the relation between health outcomes and the equality with which income is distributed in the United States. DESIGN: The degree of income inequality, defined as the percentage of total household income received by the less well off 50% of households, and changes in income inequality were calculated for the 50 states in 1980 and 1990. These measures were then examined in relation to all cause mortality adjusted for age for each state, age specific deaths, changes in mortalities, and other health outcomes and potential pathways for 1980, 1990, and 1989-91. MAIN OUTCOME MEASURE: Age adjusted mortality from all causes. RESULTS: There was a significant correlation (r = -0.62 [corrected], P < 0.001) between the percentage of total household income received by the less well off 50% in each state and all cause mortality, unaffected by adjustment for state median incomes. Income inequality was also significantly associated with age specific mortalities and rates of low birth weight, homicide, violent crime, work disability, expenditures on medical care and police protection, smoking, and sedentary activity. Rates of unemployment, imprisonment, recipients of income assistance and food stamps, lack of medical insurance, and educational outcomes were also worse as income inequality increased. Income inequality was also associated with mortality trends, and there was a suggestion of an impact of inequality trends on mortality trends. CONCLUSION: Variations between states in the inequality of the distribution of income are significantly associated with variations between states in a large number of health outcomes and social indicators and with mortality trends. These differences parallel relative investments in human and social capital. Economic policies that influence income and wealth inequality may have an important impact on the health of countries.

Adolescent↗